NEAR EAST UNIVERSITY
INSTITUTE OF APPLIED AND SOCIAL SCIENCES DEPARTMENT OF PSYCHOLOGY
CLINICAL PSYCHOLOGY
MASTER THESIS
COMPARISON OF MENTAL HEALTH PROBLEMS ACCORDING TO GENDER DIFFERENCES IN CANCER PATIENTS
HATİCE GULİZ BOLAYIR 970016
SUPERVISOR
ASSOC. PROF. DR. MEHMET ÇAKICI
NICOSIA 2009
NEAR EAST UNIVERSITY
INSTITUTE OF APPLIED AND SOCIAL SCIENCES Applied Psychology Master Program
Master Thesis
Comparison of Mental Health Problems According To Gender Differences In Cancer Patients Prepared by: Hatice Güliz Bolayır
We certify that the thesis is satisfactory for the award of the Degree of Master of Science in Applied Psychology
Examining Committee in Charge
Assoc. Prof. Dr. Ebru Çakıcı Chairman, Department of Psychology, Near East University.
Assoc. Prof. Dr. Mehmet Çakıcı Chairperson of the Psychology Department,Near East University (Supervisior)
Assoc. Prof. Dr. Güldal Mehmetçik Chairperson of the Biochemistry Department Faculty of Pharmacy Near East University
Approval of the Graduate School of Applied and Social Sciences Prof. Dr. Aykut Polatoğlu
İİİ
ÖZET
KANSER HASTALARINDA GÖRÜLEN RUHSAL PROBLEMLERİN CİNSİYET AÇISINDAN KARŞILAŞTIRILMASI
Hazırlayan Hatice Güliz Bolayır Haziran, 2009
Ruhsal hastalıkar kronik sağlık sorunları içerisinde önemli bir yer tutar. Ayrıca kişinin ruhsal durumu psikiyatrik sorunlara yol açtığı ölçüde fiziksel sağlığını derinden etkileyen sorunlara sebep olabilir. İnsanın önemli ve güncel sorunlarından olan kanser hastalığı, ne türde olursa olsun, hasta için yaşamı tehdit eden bir hastalık olarak bilindiğinden kişide rahatsızlık, sıkıntı, stres ve kaygıya yol açar. Yapılan çalışmada kanser hastalarında ruhsal problemlerin tespiti ve görülen ruhsal problemlerin cinsiyet açısından karşılaştırılması amaçlanmıştır.
Araştırma Lefkoşa Burhan Nalbantoğlu Devlet hastahanesi onkoloji bölümünde yapılmıştır.
Çalışmaya yatılı ve ayaktan tedavi gören, hastalık sürecinde 6 ayını doldurmuş olan, 50 kadın ve 50 kanser hastası alınmıştır. Çalışma kesitsel bir çalışmadır. Çalışmada demoğrafik soruların da bulunduğu genel soru formu, beck depresyon, beck anksiyete, somatizasyon- disosiyasyon ve belirti tarama ölçeği olmak üzere 4 soru formu verilmiştir. Yapılan çalışmada kadın ve erkek kanser hastalarının ruhsal durumu değerlendirilerek yaşadıkları sıkıntılarda bir farklılık olup olmadığına bakılmıştır.
Yapılan çalışmanın sonucunda kadın ve erkek hastalar arasında depresyon, kaygı, somatizasyon ve disosiyasyon durumlarında anlamlı bir farklılık çıkmıştır. Kadınların sıkıntı yaşama düzeyleri erkeklerinkinden fazla bulunmuştur.
Çalışmamızın sonucunda kadınların yaşadığı psikolojik ve ruhsal sorunların derecesinin erkeklerden fazla olduğu görülmüştür. Bu farklılığa birçok etmen neden olmakla birlikte, kadınların yeterli bilgiye sahip olmaması, kadınların hastalığa daha zor uyum sağlamaları, daha çok nüks olma durumuyla karşılaşmaları ve yaşadıkları hastalığı kadınlık ve annelik rolünde bir kayıp olarak değerlendirmeleri bu farklılığın oluşmasında en önemli etmenler olarak ortaya çıkmıştır.
Anahtar Kelimeler: Ruh Sağlığı, Kanser.
İV
ABSTRACT
COMPARISON OF MENTAL HEALTH PROBLEMS ACCORDING TO GENDER DIFFERENCES IN CANCER PATIENTS
Prepared by Hatıce Güliz Bolayır June, 2009
Mental health has a crucial role in chronic illnesses. Besides psychiatric problems, mental health status of a person can also affect the physical health of that individual which can cause problems regarding to physical health of that individual. Cancer, one of the most important and up to date health problem, is known to threat the physical health of individuals regardless to its kind where this knowledge can evoke depression, stress or anxiety in the patient. The aim of this study is to investigate the psychological problems in cancer patients and further investigate these problems in terms of gender differences.
The study had been conducted in the oncology service of Burhan Nalbantoglu Devlet Hastahanesi with 50 male and 50 female inpatients and outpatients that have been receiving treatment for more than 6 months. This study is designed as a cross-sectional study including a general questionnarie form (includes demographic questions), beck depression and beck anxiety inventory and disociation and symptom search inventory. The conducted study had compared male and female cancer patient`s mental health status to investigate the difference in psychological problems they experience.
The results of the conducted study showed that there is a significant difference in depression, anxiety, somatisation and dissociation levels of male and female cancer patients where female cancer patients experience these symptoms more than male cancer patients.
Besides these findings, the results of this study also suggest that female cancer patients experience more psychological and psychiatric problems than male cancer patients. There are many factors acting on these differences between male and female cancer patients but lack of information about the illness, having more difficulties than male cancer patients to adapt to the illness, having more relapse rates than male cancer patients and interpreting the illness as a loss of mother role and femininity can be the most important factors acting on these gender differences.
Key words: Mental Health, Cancer
V
ACKNOWLEDGEMENT
First, I would like to thank my supervisor Assoc. Prof. Dr. Mehmet Çakıcı for his support, contributions and encouregement on my thesis and all of my Professors and academic personell, that have been helpful and underistanding to me during my education.
Second, I would like to thank my brother Tuğrul for his support and help during the preparation of my thesis and other stuff and patients in Burhan Nalbantoğlu Devlet Hastahanesi.
Vİ
TABLE OF CONTENTS
Page No:
THESIS APPROVAL PAGE
ÖZET ………İİİ ABSTRACT ………..……...İV ACKNOWLEDGEMENT………....V TABLE OF CONTENTS………Vİ LİST OF TABLES……….İX ABBREVIATIONS………..Xİ
1. INRODUCTION………..1
PART I: MENTAL HEALTH………..3
1.1 Defining Mental Health……….3
1.2 History of Mental Health………..3
1.3 Dynamics of Mental Health……….4
1.4 etiology of Mental Health………5
1.5 Symptoms of Mental Health………..6
1.6 Wiews on the Factors that Affect Mental Health………...6
1.7 Epidemiology……….7
1.8 Epidemiological Studies……….7
1.9 Differing Normal from Abnormal………..8
Vİİ
1.10 İlness and Mental Structure……….8
1.11 Psychiatric Medicine ‘Concultation Liaision Psychiatry’……….10
PART II: CANCER……….11
2.1 Defination...………..11
2.2 Parts in the Body that can be Diagnosed with Cancer……….11
2.3 Symptoms and Diagnosis……….11
2.4 Treatment………..12
2.5 Reasons of Cancer………12
2.6 Etiology of Cancer………12
2.7 Epidemiology………13
2.8 Commonly Seen Problems in Cancer Patients………..13
2.9 Cancer Patient and His/her Family………...14
2.10 the Phisician’s with Cancer Patients………...15
2.11 Medical Rehabilitation of the Cancer Patients………...15
2.12 Ethics and Cancer Patients……….16
PART III: MENTAL HEALTH IN CANCER PATIENTS………17
3.1 Mental Health………..17
3.2 Important Factors Concerning Health of Cancer Patients………18
3.3 Psychological Reactions Seen in Cancer Patients………..19
3.4 Reaction Types……….20
3.5 Adaptation Problems………..20
3.6 Research on Mental Health Problems in Cancer Patients………21
3.7 Mental Health Problems in Cancer Patients in Terms of Gender…………...23
3.8 Psychological Rehabilitation in Cancer Patients……….24 Vİİİ
2-METHOD OF THE STUDY………26
2.1 The sample of the study………...26
2.2 Instruments………...26
2.2.1 Demographic Information Form……….26
2.2.2 Back Depresion inventory (BDI)………..27
2.2.3 Back Anxiety Inventory (BAI)……….29
2.2.4 Somatization and Dissociation Questionnarie (SDQ)………30
2.2.5 Symtom Check list 90- Revised (SCL 90-R)………..31
2.3 Collection of Data………..33
2.4 Data Analaysis………..33
3-RESULTS……….35
4-DISCUSSION……….52
5-CONSLUSİON………..55
BİBLİOGRAPHY………..56 APPENDIXES
İX
LİST OF TABLES
Page No:
Table 1. Comparison of mean ages of participants in terms of gender………..35
Table 2. Comparison of marital status of the participants in terms of gender…………..35
Table 3. Comparison of educational status in terms of gender……….36
Table 4. Comparison of knowledge about the diagnosis in terms of gender………37
Table 5. Comparison of information source for diagnosis in terms of gender………37
Table 6. Comparison for the period of the illness in terms of gender………..38
Table 7. Comparison of first reactions to the diagnosis in terms of gender……….39
Table 8. The relapse of the illness compared according to the gender…………...40
Table 9. Comparison of sufficient knowledge about the illness in terms of Gender……….41
Table 10. Comparison of trust to hospital and to the personell in hospital in terms of gender………42
Table 11. Comparison of attendance to therapy and treatment in terms of Gender……….43
Table 12. Comparison of talking about the illness without hesitation in terms of gender……..……….43
Table 13. Comparison of support from the family and close environment to the patients in terms of gender……….44
Table 14. Comparison of effect of the illness to the mental health in terms of gender……….45
X
Table 15. Comparison of effect of the treatment to mental health in terms of
gender……….45 Table 16. Comparison of having psychological help at the present in terms of
Gender………46 Table 17. Comparison of BDI, BAI, SDQ in terms of gender……….47 47
Table 18. Comparison of SCL- 90 R Global symptom İndex of gender………...48 Table 19. Comparison of SCL-90 R Positive Symptom Distress index in terms of
Gender………...48 Table 20. Comparison of SCL-90 R Total Positive Symptom in terms of gender…………49 Table 21. Comparison of SCL-90 R Subscales in terms of Gender………50
Xİ
ABBREVIATIONS
BNDH : Burhan Nalbantoglu devlet Hospital CLP : Consultation Liaison Psychiatry
SPSS : Statistical Package for the Social Sciences BDI : Back Depression Inventory
BAI : Back Ankiety Inventory
SDQ : Somatoform Dissociation questionnarie SCL-90-R : Symptom Check List-90 (Revised)
APPENDIXES
App-1 genel soru formu 1-cinsiyet
a-kadın b-erkek 2-yaş...
3-medeni durum a-evli
b-bekar c-boşanmış 4-eğitim düzeyi a-ilkokul b-ortaokul c-lise d-üniversite e-üniversite üzeri
5-aldığınız tanıyı biliyormusunuz?
a-evet b-hayır
6-tanınız nedir?...
7-tanıyı kimden öğrendiniz?
a-kendim öğrendim b-doktordan öğrendim
c-ailemden birinden öğrendim
8-ne kadar zamandan beridir rahatsızsınız?
Belirtiniz...
9-tanıyı ilk öğrendiğinizde ne hissettiniz? (uygun olan seçenekleri işaretle) a-inanamadım
b-şok oldum c-inkar ettim d-kaygılandım e-kızgınlık f-öfke g-suçluluk
h-diğer (belirtiniz)...
10-ilaç tedavisinin dışında kemoterapi veya radyoterapi aldınızmı?
Belirtiniz...
11-hastalığınızla ilgili nüks veya metastas durumu oldumu?
a- evet b-hayır
12-tanı veya uygulanacak tedavi konusunda aldığınız bilgi yeterlimi?
a-evet b-hayır
13-doktorlar veya hastaneye güvensizlik hissettiğiniz oldumu?
a-evet b-hayır
14-tedaviye ayaktan mı yoksa yatılımı devam ediyorsunuz?
a-ayaktan b-yatılı
15-hastalığınızla ilgili rahat konuşabiliyormusunıuz?
a-evet b-hayır
16-ailenizden ve yakın çevredan aldığınız destek yeterlimi?
a-evet b-hayır
17-ailenizde yada yakın çevrenizde benzer hastalığı olan varmı?
a-evet b-hayır
18-ailenizde veya yakın çevrenizde benzer hastalıktan dolayı kaybettiğiniz kişiler varmı?
a-evet b-hayır
19-rahatsızlığınızdan dolayı ruh sağlığınızın olumsuz etkilendiğini düşünüyormusunuz?
a-evet b-hayır
20-aldığınız tedavi ruh sağlığınızı olumsuz etkiliyormu?
a-evet b-hayır
21-daha önce psikolojik sıkıntılarınız oldumu?
a-evet b-hayır
22-daha önce psikolojik yardım aldınızmı?
a-evet b-hayır
23-ailenizde psikiyatrik rahatsızlığı olan varmı?
a-evet b-hayır
24-şu an psikolojik yardım alıyormusunuz?
a-evet b-hayır
25-rahatsızlığınızın dışında başka bir kronik rahatsızlığınız varmı?
a-evet b-hayır
app-2 Back anksiyete envanteri
Aşağıda insanların kaygılı yada endişeli oldukları zamanlarda yaşadıkları bazı belirtiler verilmiştir. Lütfen her maddeyi dikkatle okuyunuz. Daha sonra her maddedeki belirtilerin bugün dahil son bir haftadır sizi ne kadar rahatsız ettiğini aşağıdaki ölçekten yararlanarak maddelerin yanındaki uygun yere (X) işareti koyarak belirleyiniz.
0. Hiç
1. Hafif derecede 2. Orta derecede 3. Ciddi derecede
Sizi ne kadar rahatsız etti?
1-Bedeninizin herhangi bir yerinde uyuşma karıncalanma 2-Sıcak / ateş basmalar
3-Bacaklarda halsizlik, titreme 4-Gevşeyememe
5-Çok kötü şeyler olacak korkusu 6-Baş dönmesi veya sersemlik
7-Kalp çarpıntısı
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
8-Dengeyi kaybetme korkusu
9-Dehşete kapılma
10-Sinirlilik
11-Boğuluyormuş gibi olma duygusu 12-Ellerde titreme
13-Titreklik
14-Kontrolü kaybetme korkusu 15-Nefes almada güçlük 16-Ölüm korkusu
17-Korkuya kapılma
18-Midede hazımsızlık ya da rahatsızlık hissi 19-Baygınlık
20-Yüzün kızarması
21-Terleme (sıcağa bağlı olmayan)
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
app-3 Beck depresyon envanteri
Aşağıda, kişilerin ruh durumlarını ifade ederken kullandıkları bazı cümleler verilmiştir. Her madde bir çeşit ruh durumunu anlatmaktadır. Her maddede o ruh durumunun derecesini belirleyen 4 seçenek vardır. Lütfen bu seçenekleri dikkatle okuyunuz. Son bir hafta içindeki (şu an dahil) kendi ruh durumunuzu göz önünde bulundurarak, size en uygun olan ifadeyi bulunuz. Daha sonra o maddenin yanındaki harfin üzerine (X) işareti koyunuz.
1-a.kendimi üzgün hissetmiyorum b-kendimi üzgün hissediyorum
c.her zaman için üzgünüm ve kendimi bu duygudan kurtaramıyorum d.öylesine üzgün ve mutsuzum ki dayanamıyorım
2-a.gelecekten umutsuz değilim b.geleceğe biraz umutsuz bakıyorum c.gelecekten beklediğim hiçbirşey yok
d.benim için gelecek yok ve bu durum düzelmeyecek
3-a.kendimi başarısız görmüyorum
b.çevremdeki birçok kişiden daha fazla başarısızlıklarım oldu sayılır c.geriye dönüp baktığımda çok fazla başarısızlığımın olduğunu görüyorum d.kendimi tümüyle başarısız bir insan olarak görüyorum
4-a.herşeyden eskisi kadar zefk alabiliyorum b.herşeyden eskisi kadar zefk alamıyorum c.artık hiçbirşeyden gerçek bir zefk alamıyorum d.bana zefk veren hiçbirşey yok. Herşey çok sıkıcı
5-a.kendimi suçlu hissetmiyorum
b.arada bir kendimi suçlu hissettiğim oluyor c.kendimi çoğunlukla suçlu hissediyorum d.kendimi her an için suçlu hissediyorum
6-a.cezalandırıldığımı düşünmüyorum
b.bazı şeyler için cezalandırılabileceğimi düşünüyorum c.cezalandırılmayı bekliyorum
d.cezalandırıldığımı hissediyorum
7-a.kendimden hoşnutum
b.kendimden pek hoşnut değilim c.kendimden hiç hoşlanmıyorum d.kendimden nefret ediyorum
8- a.kendimi diğer insanlardan daha kötü görmüyorum b.kendimi zayıflıklarım ve hatalarım için eleştiriyorum c.kendimi hatalarım için çoğu zaman suçluyorum d. her kötü olayda kendimi suçluyorum
9-a.kendimi öldürmek gibi düşüncelerim yok
b.bazen kendimi öldürmeyi düşünüyorum fakat bunu yapamam c.kendimi öldürebilmeyi isterdim
d.bir fırsatını bulsam kendimi öldürürdüm
10-a. her zamankinden daha fazla ağladığımı sanmıyorum b.eskisine göre şu sıralarda daha fazla ağlıyorum c.şu sıralarda her an ağlıyorum
d.eskiden ağlayabilirdim ama şu sıralar istesamde ağlayamıyorum
11-a.her zamankinden daha sinirli değilim
b.her zamankinden daha kolayca sinirleniyor ve kızıyorum c.çoğu zaman sinirliyim
d.eskiden sinirlendiğim şeylere bile artık sinirlenemiyorum
12-a.diğer insanlara karşı ilgimi kaybettim b.eskisine göre insanlarla daha az ilgiliyim c. diğer insanlara karşı ilgimin çoğunu kaybettim d.diğer insanlara karşı hiç ilgim kalmadı
13-a.kararlarımı eskisi kadar kolay ve rahat verebiliyorum b.şu sıralar kararlarımı vermeyi erteliyorum
c.kararlarımı vermekte oldukça güçlük çekiyorum d.artık hiç karar veremiyorum
14-a.dış görünüşümün eskisinden daha kötü olduğunu sanmıyorum b.yaşlandığımı ve çekiciliğimi kaybettiğimi düşünüyor ve üzülüyorum
c.dış görünüşümde artık değiştirilmesi mümkün olmayan olumsuz değişiklikler olduğunu hissediyorum
d.çok çirkin olduğumu düşünüyorum
15-a.eskisi kadar iyi çalışabiliyorum
b.bir işe başlayabilmem için eskisine göre kendimi daha fazla zorlamam gerekiyor c.hangi iş olursa olsun yapabilmek için kendimi çok zorluyorum
d.hiçbir iş yapamıyorum
16-a.eskisi kadar rahat uyuyabiliyorum
b.şu sıralarda eskisi kadar rahat uyuyamıyorum
c.eskisine göre bir veya iki saat daha erken uyanıyor ve tekrar uyumakta zorluk çekiyorum d.eskisine göre çok erken uyanıyor ve tekrar uyuyamıyorum
17-a.eskisine kıyasla daha çabuk yorulduğumu sanmıyorum b.eskisinden daha çabuk yoruluyorum
c.şu sıralar neredeyse her şey beni yoruyor d.öyle yorgunum ki hiç bir şey yapamıyorum
18-a.iştahım eskisinden pek farklı değil b.iştahım eskisi kadar iyi değil c.şu sıralarda iştahım epeyi kötü artık hiç iştahım yok
19-a.son zamanlarda pek fazla kilo kaybettiğimi sanmıyorum b.son zamanlarda istemediğim halde üç kilodan fazla kaybettim c. son zamanlarda istemediğim halde beş kilodan fazla kaybettim d. son zamanlarda istemediğim halde yedi kilodan fazla kaybettim
20-a.sağlığım beni pek endişelendirmiyor
b.son zamanlarda ağrı, sızı, mide bozukluğu, kabızlık gibi sorunlarım var
c.ağrı sızı gibi bu sıkıntıların brni epeyi endişelendirdiği için başka şeyleri düşünmek zor geliyor
d.bu tür sıkıntılar beni öylesine endişelendiriyor ki, artık başka hiçbir şey düşünemiyorum
21-a.son zamanlarda cinsel yaşamımda dikkatimi çeken birşey yok b.eskisine oranla cinsel konularla pek az ilgileniyorum
c.şu sıralarda cinsellikle pek ilgili değilim d.artık cinsellikle pek ilgim kalmadı
app-4 Somatoform – disosiyasyon ölçeği
Lütfen aşağıdaki sorularda belirtilen durumların sizinkine ne kadar uyduğunu değerlendiriniz ve her soru için buna uyan cevabı işatetleyiniz.
1-bazen sanki vücudum yada vücudumun bir bölümü yok oluyor gibi geliyor 1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
2-bazen bir süre felç oluyorum
1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
3-bazen konuşamaz hale geliyorum yada ancak güçlükle yada fısıltı halinde konuşabiliyorum 1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
4-bazen vücudum yada vücudumun bir bölümü acı hissetmez oluyor 1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
5-bazen idrar yaparken acıyor
1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
6-bazen kısa bir süre için gözlerim görmüyor, sanki kör oluyorum 1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
7-bazen idrar yaparken tutukluk oluyor
1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
8-bazen kısa bir süre için kulaklarım işitmiyor, sanki sağır oluyorum 1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
9-bazen yanımdaki sesleri çok uzaktan geliyormuş gibi duyuyorum 1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
10-bazen bir süre için her yanım katılaşıyor
1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
11-bazen nezle olmadığım halde koku alma hissim her zamankine göre azalıyor yada çoğalıyor
1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
12-bazen cinsel organlarımda ağrı oluyor (cinsel ilişki dışında) 1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
13-bazen havaleye benzer bir bayılma nöbeti geçiriyorum
1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
14-bazen normalde sevdiğim bir kokudan hoşlanmaz oluyorum 1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
15-bazen normalde sevdiğim bir yiyeceğin tadından hoşlanmaz oluyorum (kadınlarda hamilelik dışında)
1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
16-bazen çevremdeki eşyaları her zamankinden farklı görüyum 1-hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
17-bazen gece boyunca uyuyamadığım halde gündüz gayet zinde oluyorum 1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
18-bazen yiyecekleri yutamıyorum yada yutmakta zorluk çekiyorum 1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
19-bazen insanlar ve insanlar olduklarından daha büyük görünüyorlar 1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
20-bazen vücudum ya da vücudumun bir bölümü hissiz oluyor 1.hayır... 2-biraz... 3-orta derecede... 4-çok... 5-tam...
app-5 Belirti tarama listesi
Aşağıda zaman zaman olabilecek yakınma ve soruların bir listesi vardır. Lütfen her birini dikkatle okuyunuz ve yanlarındaki boşluğa durumun sizde ne ölçüde bulunduğunu bildirir numarayı, cevaplama anahtarına bakarak yazınız. Yanıt verirken bugün dahil son bir ayı düşününüz.
0...hiç 1...çok az
2...orta derecede 3...çok
4...ileri derecede
Aşağıda belirtilen sorundan ne ölçüde rahatsız olmaktasınız?
1- Baş ağrısı...
2- Sinirlilik yada içinin titremesi...
3- Aklınızdan atamadığınız tekrarlayıcı, hoşa gitmeyen düşünceler...
4- Baygınlık yada baş dönmesi...
5- Cinsel arzu ve istek kaybı...
6- Başkaları tarafından eleştirilme duygusu...
7- Herhangi bir kişinin düşüncelerinizi kontrol edebileceği düşüncesi...
8- Sorunlarınızdan çoğu için başkalarının suçlanması gerektiği duygusu...
9- Olayları hatırlamada güçlük...
10- Dikkatsizlik ve sakarlıkla ilgili endişeler...
11- Kolay gücenme rahatsız olma duygusu...
12- Göğus veya kalp bölgesinde ağrılar...
13- Cadde veya açık alanlarda korku duygusu...
14- Enerjinizde, gücünüzde yavaşlama, azalma hali...
15-Yaşamımızın sonlanması düşünceleri...
16-Başka kişilerin duymadıkları sesleri duyma...
17-Titreme...
18-Çoğu kişiye güvenilmemesi duygusu...
19-İştahsızlık...
20-Kolayca ağlama...
21-Karşı cinsten kişilerle utangaçlık, rahatsızlık duygusu...
22-Tuzağa düşürülmüş yada yakalanmış olma duygusu...
23-Bir neden olmaksızın aniden korkuya kapılma...
24-Kontrol edilemeyen öfke patlamaları...
25-Evden dışarı çıkma korkusu...
26-Olaylar için kendini suçlama...
27-Belin alt kısmında ağrılar...
28-İşlerin yapılmasını sık sık erteleme duygusu...
29-Yalnızlık duygusu...
30-Karamsarlık duygusu...
31-Herşey için çok fazla endişe duyma...
32-Herşeye karşı ilgisizlik hali...
33-Korku duygusu...
34-Duygularınızın kolayca incinebilmesi hali...
35-Diğer insanların sizin özel düşüncelerinizi bildiğini düşünme...
36-Başkalarının sizi anlayamayacağı veya hissedemeyeceği duygusu...
37-Başkalarının sizi sevmediği veya dostça davranmadığı duygusu...
38-İşlerin doğru yapıldığından emin olmak için çok yavaş yapmak...
39-Kalbin çok hızlı çarpması...
40-Bulantı yada midede rahatsızlık duygusu...
41-Kendini başkalarından aşağı görme...
42-Kas ağrıları...
43-Başkalarını sizi gözlediği veya hakkınızda konuştuğu duygusu...
44-Uykuya dalmada güçlük...
45-Yaptığınız işleri bir veya birkaç kez kontrol etmek...
46-Kararsızlık...
47-Otobüs, tren gibi araçlarla yolculuk etme korkusu...
48-Nefes almada güçlük...
49-Soğuk veya sıcak basması...
50-Sizi korkutan belli yer, nesne veya uğraşlardan kaçınmak...
51-Hiçbirşey düşünememe durumu...
52-Bedeninizin bazı kısımlarında uyuşma, karıncalanma...
53-Boğazınıza bir yumru takılma duygusu...
54-Gelecek konusunda umutsuzluk...
55-Düşüncelerinizi bir konuya yoğunlaştırmada, konsantre olmada güçlük...
56-Bedeninizin çeşitli kısımlarında zayıflık hissi...
57-Gerginlik yada coşku duygusu...
58-Kol ve bacaklarda ağırlık hissi...
59-Ölüm yada ölma düşünceleri...
60-Aşırı yemek yeme...
61-İnsanlar size baktığında yada hakkınızda konuştığunda rahatsızlık...
62-Size ait olmayan düşüncelere sahip olma...
63-Bir başkasına vurma, yaralama, zarar verme dürtüler...
64-Sabahın erken saatlerinde uyanma...
65-Bazı şeyleri kırıp dökme isteği...
66-Uykuda huzursuzluk, rahat uyuyamama...
67-Bazı şeyleri kırıp dökme isteği...
68-Başkalarının paylaşıp, kabul etmediği inanç ve düşünceler...
69-Başkalarını yanında kendini çok sıkılgan hissetme...
70-Çarşı, sinema gibi kalabalık yerlerde rahatsızlık duygusu...
71-Herşeyin yük gibi görünmesi...
72-Değşet ve panik nöbetleri...
73-Toplum içinde yer içerken huzursuzluk duygusu...
74-Sık sık tartışmaya girme...
75-Yalnız bırakıldığında sinirlilik hal...
76-Başkalarının size başarılarınız için yeterince taktir etmediği duygusu...
77-Başkalarıyla birlikte bulunulan durumlarda bile yalnızlık hissetme...
78-Yerinizde duramayacak ölçüde rahatsılık hissetme...
79-Değersizlik duygusu...
80-Size kötü birşey olacakmış duygusu...
81-Bağırma yada eşyaları fırlatma...
82-Topluluk içinde bayılacakmışsızız korkusu...
83-Eğer siz izin verirseniz insanların sizi sömüreceği duygusu...
84-Cinsiyet konusunda sizi çok rahatsız eden düşünceler...
85-Günahlarınızdan dolayı cezalandırılmanız gerektiği düşüncesi...
86-Korkutucu türden düşünce ve hayaller...
87-Bedeninizde ciddi bir rahatsızlık olduğu düşüncesi...
88-Başka bir kişiye karşı asla yakınlık duymama...
89-Suçluluk duygusu...
90-Aklınızdan bir bozukluğun olduğu düşüncesi...
1-INTRODUCTION
The concept of mental health is one of the most interesting questions by human beings and the history of mental health is as old as the human history. It is known that biological, psychological and sociological factors can cause mental health problems and it can be said that these factors can be affective on their own or with each other according to different situations (Hançerlioğlu,1997).
General description of a good mental health includes: Realistic perception, power to struggle, accepting his/herself as it is, emotion of safety, not repeating the same mistakes and directing his/her love and respect to positive areas (Baymur,1993).
The symptoms of mental health problems vary according to different types of problems.
Some of the most important factors that determine the symptoms of these problems can be the person`s overall look, behavior, facial expressions, mimics, emotions, perception, ingredients of the thoughts, level of knowledge and the intelligence. Another factor that has to be underlined is the occurrence of other health problems in the person where physical problems and illnesses can also affect the mental health of the person and they are also seen as another factor that affect our lives (Ankay, 1998; Baltaş,2000).
Mental health problems vary according to countries or societies. It is shown that mental health problems are more in societies with low socioeconomic status than societies with high socioeconomic status. It is also reported that more mental health problems are seen in societies with low education level (Sayıl, 2000; Köroğlu,1998).
Deep and intense emotional pains, loss of a loved one and physical or chronic illnesses that can lead to death affect a person`s psychology, relationships, everyday activities and lifestyle in a negative way (Ankay, 1998).
A physical illness effects the homeostasis of a person where this change in the homeostatic balance is reflected as emotional reactions. A physical illness can lead to negative emotions such as depression or sadness. With those negative emotions, patients with chronic psychological problems can experience physical or chronic problems. (Özkan 2008).
Chronic illnesses such as, cancer, diabetes, heart or kidney diseases usually effect the mental structure in a destructive way where the patient goes back and forth between emotions such as hopefulness and accepting or rejecting the depression (Ankay, 1998).
The experience of a physical illness leaves the patient with the truth that a living being can get harmed anytime and can beextremely aggitated. Emotional reactions and problems cause maladaptation to the physical illness.Every physical illness can be seen as a crisis. A loss, grief, a separation, future anxiety, and the anxiety that the organs in the body can get harmed affects the patient`s social perceptions, body image, emotional structure and physical balance (Güveli, 2008).
Factors such as age, sex, education, personality characteristics of the patient and type and the location of the cancer on the body determines the patient`s adaptation to the illness and how heaviling the illness can affect the patient`s family relationships, work and life (Özkan, 1993).
The occurrence or the degree of occurrence of these psychological problems differ according to structure of the patient`s personality, and the degree of, perception of the illness, phase of the illness, side effects of the treatment, psychological maturity, family support, performance capacity, loss of a loved one in the past, knowledge about the illness, family structure, lifestyle, education level, social and cultural factors and economic position of the patient (Doğan, 2000; Ersoy, 2000).
Lack of support, insufficiency of information about the illness, duration and the ingredients of the medications can cause stress and psychological problems in the patient (Bolayır, 2006).
Personality features of the patient is one of the factors that can effect the adaptation to the illness, future plans and social and cultural ideas and views about the illness (Özkan MB, 1996).
Psychological rehabilitation is important for both the patient and his/her family because living with such a dangerous and chronic illness effects the patient`s psychological health and social relationships in a negative way. (Özkan. MB, 1996; Özkan, 1993 ).
PART I: MENTAL HEALTH
1.1 DEFINING MENTAL HEALTH
According to WHO, mental health is explained as being in harmony with the environment and the self (Öztürk, 1997; Ankay, 1998).
General description of a good mental health includes: Realistic perception, power to struggle, accepting his/herself as it is, emotion of safety, not repeating the same mistakes and directing his/her love and respect to positive areas (Baymur, 1993; Hançerlioğlu; 1997, Baltaş ,2000).
The aim of the mental health practitioners is to observe, classify and treat the disturbances in the person`s emotions, behaviors and his/her harmony with the environment (Ankay, 1998;
Hannçerlioğlu, 1997).
Mental health can be studied in two sections as protective and therapeutic. The protective part includes the precautions taken before the illness and the therapeutic part includes the rehabilitation of the illness (Öztürk, 1997)
1.2 HISTORY OF MENTAL HEALTH
The term mental health is as old as the mankind history and it is one of the most interesting question that human beings tries to answer. In primitive ages illness was related to supernatural forces and people were trying to get rid of these illnesses by weird ceremonies (Baymur, 1993)
Primitive ages starts with Hippocrates period. In those ages, Hippocrates proved that the illnesses were related and caused by the natural factors,and they were not supernatural.
Hippocrates was the one to prove that illnesses were related to holy factors such as hysteria or melancholia, where it was proven that epilepsy was related with the brain and hysteria was related to genitalias instead of evil souls. Plato and Aristotle were the ones that supported these ideas. Psychodrama, psychotherapy and dream interpretations were some of the different suggestion techniques that have been used in those ages. Unfortunately, this enlightened period didn`t last long where magical and mysterical thinking became dominant
with the regression of middle ages where in Western World this was known as the Dark Ages (Öztürk, 1997; Ankay,1998).
İn the Middle Age Europe, mentally ill or disturbed people were known to work or cooperate with the evil so they were burned alive. With this reason, thousands of schizophrenic, manic and hysteric people had lost their lives by being burned alive where people thought that their souls were captured by the evil. Because of church’s solid and premise rules, many mentally ill people had been tortured in dungeons (Hançerlioğlu, 1997).
By the increase of interest in art and science in Renaissance, there have been many protests for the burnings but these protests had ended with many different punishments as well (Baltaş, 2000).
There had been many changes in the field of science after the 16th and the 17th century, and it had been decided that it would be the best for mental health practitioners to deal with their problem and make decisions about disturbed or unhealthy people. There are many different important studies of psychiatry in 19th century where studies lead the professionals to diagnose and classify mental illnesses. These improvements had been fastened up after the World War II (Ankay,1998; Hançerlioğlu, 1997; Baltaş, 2000).
At the second half of the 20th century, psychiatry had divided into different branches such as descriptive, dynamic or behavioral where after these important steps, mental physician has to gain importance (Baltaş, 2000; Karan 1977).
1.3 DYNAMICS OF MENTAL HEALTH
1-Descriptive Theory: This theory had been noticed and suggested by Kreplin and Bleuler. In this method, it`s important to diagnose and classify the mental health problems. There is a crucial role for understanding and classifying the illnesses from each other.
2-Biological Theories: It underlines the importance of the genetics, biochemistry, neurophysiology and pathology of the illnesses and uses methods such as EEG or brain tomography to study illnesses in this view.
3-Behaviourism: Includes the rules and factors of learning where it studies the effects of learning on behaviors and lives of people. Seligman, Skinner or Bandura can be such good examples for this view.
4-Dynamic Theories: It`s the technique of psychoanalysis presented by Freud. Scientists such as Adlar, Klein, Eric Fromm, K. Honey and Eric Ericson had added ideas to it as well where this view includes concepts such as ego psychology, self awareness, object relations, unconscious or psychosexual steps of development.
5-Phenomenological and Existential Theories: Tries to understand the real inner world of the patients and underlines the importance of personal experiences.
6-Cognitive Theories: Underlines the importance of mental concepts such as memory or thinking and studies the relationship between the different types of cognitive concepts and observable behaviors (Cüceloğlu, 1998; Köroğlu, 1998).
1.4 ETIOLOGY OF MENTAL HEALTH
It can be said that mental health problems are caused by psychological, biological or sociological factors where these factors can be affective on their own or with combination of other factors
1-Biological factors: Underlines the importance of the biochemistry and the genetics of mental health problems. It suggests that factors such as biological development, genetics, abnormalities of genetics in the brain, physical structure and the health of the person, deficiencies in nutrition and physical traumas can be effective in the formation of mental health problems.
2-Psychological factors:
- At the period of childhood: Insufficiency of the mother, negligence, refusal, extreme fear, not letting the child to be autonomous, unorganized family structure, extreme pressure, an inconsistent discipline system, absence of identification, comparisons, extreme expectations, mentally unfit parents and insufficient education.
- At the period of adulthood: Concrete or abstract failures, loss of loved ones, conflicts and symptoms carried throughout the childhood and a corrupted lifestyle.
3-Sociological Factors: A corrupted education system or tradition of a society, being excluded from the society, being very dependent on a society and losing his/her identity and social stressors such as; unemployment, immigration, social pressure and rapid social changes (Öztürk, 1997; Baltaş, 2000; Sayıl, 2000).
1.5 SYMPTOMS OF MENTAL HEALTH DISORDERS
Symptoms of mental health problems vary according to the type and the category of the problem. General looks, behaviors, facial expressions, gestures, mimics, emotions, speaking, perception, contents of the thoughts, level of knowledge, inner vision and the intelligence are important factors to be considered. Existence of another problem or illness is one of the most important factor that should be considered as well because just like other external factors, physical problems or illnesses are important factors that can affect the mental health of the person (Yurdakul, 1999).
1.6 VIEWS ON THE FACTORS THAT AFFECT MENTAL HEALTH
Toffler: Toffler believes that the rapid changes caused by the technology make people sad and causes fear of future.
Eric Fromm: Fromm believes that human being is prisoned by today`s technology and they have the inability to express their emotions where this results in a different kind of depression them. Fromm also believes that extreme competition causes arousal in the person where this disturbs the mental health.
Karen Honey: Honey believes that pollution of the nature, extreme competition, war hysteria, corrosion of moral values, excessive stimulation, estrangement, valuing everything with money and the increase of heart diseases and cancer affects mental health in a negative way and causes an increase in the formation of mental disorders, suicides, crimes and addictions (Yurdakul, 1999).
1.7 EPIDEMIOLOGY
Mental health problems play an important role in chronic health problems. Besides psychiatric problems, a person`s mental health can also cause changes in general health. With that perspective, it can be said that mental health problems both need to be under control of a medical institution and a multidisciplinary approach. Mental health problems are considered as important problems because they can affect the life quality of a person. From past to present, epidemiological studies in the area of mental health problems has lead professionals to evaluate the problems in a social dimension (Karan, 1977).
Mental health epidemiology includes studies on the diagnosis of mental health problems, dispersion of these problems in the society and the reasons of these problems. There is a big difference of dispersion for mental health problems for different countries and societies. It was proved that countries with low socioeconomical status have more people with mental health problems then other countries and it was also reported that mental health problems are higher in countries with low education level. Depression, mood disorders and hysteria are more common in women where alcoholism, addiction to substances and antisocial personality disorders are more common in men. Common ages for these disorders had been reported as 25-45 where it had also been reported that these disorders tend to increase depending directly on the increase of civilization (Sayıl, 2000; Köroğlu, 1998).
1.8 EPIDEMOLOGICAL STUDIES
According to statistics, 12% of the children and 15% of adults in USA have the probability to have a mental disorder. In Turkey, 20% of the population has a mental disorder that needs professional help. According to a study in Turkey, 32% of the families have psychiatric disorders where these disorders tend to appear three times more in uneducated people compared to people with high education levels and these disorders are more common in places with low socioeconomic levels and becomes more common for people at the ages of 50 and 55 where the effects of these disorders are stronger at these ages (Öztürk, 1997;
Yörükoğlu,1997).
1.9 DIFFERING NORMAL FROM ABNORMAL
A mentally healthy person can be described as being in harmony with the environment and not having extreme levels of anxiety and conflicts. A person having trouble with mental health problems usually have inconsistent emotions, thoughts and behaviors where these factors can also have extreme and inappropriate characteristics.
Describing a normal person in a statistical way, it can be said that s/he is the one that fits into the society and doesn`t stand in extreme ends. Although, not having a problem or disorder that doesn`t need clinical or professional help, doesn`t mean that a person is mentally healthy.
The reason for this is not having “definite” borders between a mentally healthy and a mentally unhealthy person. Therefore, factors such as education level, life standards, social environment and the social standards should be considered (Öztürk, 1997; Köroğlu, 1998).
1.10 ILLNESS AND MENTAL STRUCTURE
Deep emotional pain, such as loss of a loved one or chronic illnesses that can cause the fear for death can affect a person`s psychology, social relationships, daily habits and lifestyle in a negative way (Güveli, 2008).
Chronic illnesses usually have deep emotional effects on people where this usually leads them to travel emotionally between depression-hope and acceptance-refusal of the illness (Ankay, 1998).
Experiencing an illness leaves people with the fact that they are sensitive and can get hurt anytime during their lifetime. Commonly seen reactions to the illness can be listed as emotional reactions and adaptation difficulties to the illness. Every chronic illness can be seen as a crisis. Factors such as loss of a loved one, grief, separation, future anxiety, fear of death and the anxiety of getting harm to any part of the body can affect patient`s mental processes and health, physical and emotional anatomy, body image and social perceptions (Güveli, 2008).
Psychological reactions developed by the patient depends on the structure of the personality, past experiences about the illness, reaction of the family to the illness, attitudes about the role of a “patient” and the importance of the illness for the person (Özkan, 2001).
The personality of the patient with emotional reactions to the illness changes at the end of the struggle with the illness where finally, patient starts to give most economical psychological reactions for the events and situations to save energy (Sayıl, 2000; Köroğlu,1998).
Psychological reactions from the patient:
*Some patients tend to stay away from the responsibilities and the anxieties by bonding to the family and searching for attention.
*Some patients tend to refuse their illness. These patients don`t care about the potential causes of the illness because the illness is a source of stress for them where they are also afraid to become dependent on someone. They usually try to behave like they don`t care about the illness.
*Some patients tend to accept the illness and trust themselves. They try to let their fears come to light and let their fears become visible and try to fight with them (Köroğlu, 1998).
Every patient uses a psychological defense mechanism to keep their psychological health in balance. These psychological defense mechanisms can be listed as:
1- Recession: Patients with this kind of reaction seek attention and treatment. They can behave depressive, aggressive, impatient where these behaviors can affect the treatment in a negative way.
2- Reaction formation: Patients with this kind of reaction tend not to believe the physician`s diagnosis and don’t obey the advises given.
3-Denial: This kind of reaction is usually seen at the beginning of the illness and the patient tends not to believe and accept his/her illness.
4-Reflection: This kind of reaction is the reflection of the patient`s hostile emotions to the authorized person. The patient keeps other people responsible for the things that s/he goes through. A medical environment and being dependent on other people causes emotions such as fear and being unable to protect his/her self. Patients with this kind of reaction are usually very sensitive.
5-Daydreaming and Imagining: Patients with this kind of reaction usually tend to imagine pleasant things instead of painful experiences. They usually tend to get away from the
fact that they are sad where instead of thinking about painful facts and experiences, they try to adopt into the medical environment (Medicana Sağlık Ansiklophedisi, 1998)
1.11 PSYCHIATRIC MEDICENE “CONSULTATION LIAISION PSYCHIATRY Consultation- liaison psychiatry is a discipline of psychiatry where it depends on cooperation with other branches such as clinical medicine or different expertise and it tries to increase the connection and interaction between psychic and psychosocial conditions. It also accompanies to other physical illnesses in the world of medicine and can also be seen as a discipline that deals with the psychiatric symptoms, psychosocial problems and their diagnosis (Özkan, 2006)
The difference between psychotherapy and Consultation Liaison Psychiatry: Psychotherapy can`t be applied in standard conditions. The criteria of choosing the patient can`t be applied as well where it`s not the patient`s decision to see the psychiatrist or not (Özkan, 2006).
Aims and the Uses of consultation liaison psychiatry: CLP aims to get a good anamnesis and story of the patient, form a positive therapeutic cooperation, increase the empathy and self respect, decrease the emotions that harm or hurt the patient and reactions to the events, form a healing environment and psychodynamic formulation and determine the therapy plan (Köroğlu, 2006).
PART II: CANCER
2.1 DEFINITION
It can be defined as the uncontrolled increase and spread of abnormal cells. Unlike their normal activity, cells in the body start to multiply quickly and also spread to other tissues that they are not related and demolish their structures (Türk Kanser Araştırma ve Savaş Vakfı , 2000).
2.2 PARTS IN THE BODY THAT CAN BE DIAGNOSED WITH CANCER
Cancer can be seen in the body in various forms. It can be seen on the tissues or on the organs. It can be seen as leukemia which is a result of insufficient activities of the marrow. It can also be seen on the most important part of our bodies, lymph glands,which leads to lymphoma. Cancer can be seen in various forms such as eye, tongue, pharynx, intestine, urinary bladder, pancreas, liver, lung, heart, cervix, uterus, prostate, and breast and skin cancer. The most common ones are leukemia, lymph, rectum, intestine, prostate, uterus and the Breast cancer. Various types of cancer have different kind of symptoms and different kinds of healing periods. Almost every type of cancer has the risk of spreading to another organ or tissue or has the risk of reoccurence (Türk Kanser Araştırma ve Savaş Vakfı , 2000).
2.3 SYMPTOMS AND DIAGNOSIS
Changes in the urination and excrementation habits, unhealing wounds for long periods, unexpected bleeding and leaking in the body, bumps in definite places of the body that can be felt by the hand, difficulty in swallowing and digestion, clear changes on moles and long term coughing and hoarse are the common symptoms seen in various types of cancer (Türk Kanser Araştırma ve Savaş Vakfı , 2000).
2.4 TREATMENT
From the past to the present, cancer has been tried to be treated in different ways. Today`s technology offers different treatment methods for cancer where these methods have started to be applied on cancer patients and measured for success rates. Despite today`s technological treatment methods, there are some basic treatment methods that are still applied to the patients. If needed, usually the tumor or the infected tissue is removed by an operation and then treatment program is selected according to the age, gender, physical characteristics, and other health problems of the patient where also the type of the cancer is considered in the selection of treatment. This program (treatment) includes radiotherapy and chemotherapy.
The frequency and the period of these treatment programs depends on the patient`s condition on how s/he reacts to the treatment (Türk Kanser Araştırma ve Savaş Vakfı , 2000; Meydan Laruse Ansiklophedisi, 1992).
2.5 REASONS OF CANCER
There are many factors that can cause cancer. These can be; genetics (hereditary), substances in foods, smoking, alcohol addiction, incorrect and irregular eating habits, environment pollution, contact with toxic substances, radiation, sunlight, specific viruses, medicines, immune system disorders, lifestyles and life conditions and stress (Akdağ, 2008).
2.6 ETIOLOGY OF CANCER
Despite biological and environmental factors that can cause cancer, there are also psychological factors like unconscious stressors and conflicts. After the patient finds out his/her situation about cancer, s/he perceives that situation with the society`s view where cancer is perceived as a fatal illness and after these thoughts, usually the treatment is rejected by the patient where this rejection is usually followed by anxiety. In a study for cancer with outpatients, results showed that 70% of female knew how to examine their breasts for cancer with their hands, 19% have applied that procedure, 22% couldn`t couraged themselves to apply this procedure and 14% only had information about this by non-professional ways such as having information from their friends or from the environment (Pazdur and friends 2005- 2006).
2.7 EPIDEMIOLOGY
Every year, 15-30.000 of adults had been diagnosed with cancer in every 100.000 people. In adults, 60% and in children, 77% of cancer patients have the chance for recovery. In 1970`s, cancer had the fourth place in the list of fatal illness that caused death in Turkey, whereas today, death rate is the secont and the cardiovascular diseases has teken the first place in the list (Spiegel, 1997).
Women have more chance to be diagnosed by cancer than men. It`s known that cancer types such as lung, digestion, skin, prostate and bladder are seen more in men than in women where breast, colon, uterus and cervix cancer are seen more in women. People who had cancer in their families have more chance to be diagnosed by cancer than other people who have no history of cancer in their families (Kanserle Savaş Ulusal Federasyonu, 1997).
In a study conducted in North Cyprus in 1988-1989, it was found that 60% of the cancer patients were female and 40% were male where this shows that the percentage of women with cancer in those years were more than men with cancer. In those years, 123 new cases had been diagnosed with cancer (Elgin, 1989).
2.8 COMMONLY SEEN PROBLEMS IN CANCER PATIENTS
Problems in mental health: Problems such as anger, helplessness or denial can be seen in cancer patients. They can be more sensitive and fragile than normal. In a study, 47% of cancer patients had been diagnosed with mental health problems (Kurul, Topuz, 2000).
Problems in psychophysiology: Excessive sleep can be seen in the patients as a denial of the situation where sleep can be perceived as an escape from the situation or problem. Again, problems in the sleep can be seen as well where the patient can`t sleep because of the fear of dying. There can be problems with the appetite where different kinds physical problems can be seen as a result of side effects of the treatment. There can be problems in sexuality as well where decrease in sexual interest or an escape from sexual relationships can be one of those problems (Kurul, Topuz, 2000; Kömürcü, Dinçer, 2003)
In a study conducted in Ege Medical Faculty with 107 cancer patients, results had showed that 84.3% of the patients escape from sexual relationships, 42.8% of the patients have the problem not to perceive themselves as a partner and 84% of the patients have tension before a sexual relationship (Gürkan, 2000).
